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[Hezzi]

Hi! Just wondering if anyone had an opinion on this?

I've been post menopausal for about 3 or 4 years.
I started on combined Evorel 50 from May following night sweats, hot flashes, loss of self (don't know how else to describe this) and other issues. I've been on this with no issues until Christmas last year when, after a virus my hormones went mad and I suffered a lot of anxiety though also had a little spotting. On checking with gp, she was not that bothered about the spotting and felt she'd be more concerned if there was "proper blood"
and backed this up with my clear scan from last year.

 Gp changed hrt to Evorel 75 with provera pill. I've been on this now for a month and pretty much have had very sore boobs and spotting for 3 weeks with intermittant cramping. Is this normally? My next review (on telephone)with gp is in 2 months time.

Due to the sore/tender boobs and daily  spotting, I got a bit fed up and was convinced the patch was providing too much oestrogen, so I've switched back to Evorel 50.

I'm now not sure if I've acted a bit hastily! Though through posts by others I understand spotting etc is a known side affect that lots of us have, and I'm probably second guessing myself and getting a bit stressed.

Do you think I have should have given the Evorel 75 and Provera more time and go back on it or just wait and see how it goes with the old hrt Evorel 50?.

[CLKD]

Hi!  if the previous regime was working why change?

Your GP is probably unaware that certainly Covid-19 caused many women World Wide upheaval with hormones, some bleeding for the first time in many years.  So it stands to reason that other viruses may also impact.

Keeping a mood/food/symptom diary may be of use. 

[Hezzi]

Thanks CLKD!

Good point re don't fix it if it's not broke!  I think neither of us were aware at the time that viruses could cause so much upset!

I have kept a "symptom" diary since Christmas and it's been vital to remembering what happened and when - especially with Menopause brain!

[CLKD]

Oh join the Menopause Fuggy Brain Club  .  I can't remember if I've 'been' so. have to tick the calendar  .

Let us know how you get on.

[Hezzi]

Just an update... though its maybe too early to tell, but breast tenderness seems less, though spotting is much more pink like a bleed than it was before (brown). Any idea why this change?

As I'm getting more anxious about this, I've called gp to get a scan arranged and have a f2f appt later in the month.

Any thoughts very welcome!

[CLKD]

Hormones.  They rise and fall all month long, when we go into peri they can alter in that sometimes there isn't enough hormone to 'push' a proper period.  I would get a brown show 2 days after each bleed 

It's The Change, does what it says on the tin!

[Hezzi]

An update and wondering if any (of you very helpful) ladies have advice...?!
I decided to go back to Evorel 50 patch from the Evorel 75 and provera pill about a month ago as I felt I was getting too much oestrogen and had gotten fed up with the constant spotting, cramping and very sore breasts. Since the switch, things gradually got better. Breast pain, spotting, cramping and bloating all reduced and everything seemed fine.
As I had unexpected spotting, gp arranged an ultrasound (about 2 weeks ago now) and everything came back normal.
In the last few weeks I've had what feels like my vagina is lower and I've been a bit damp down there (I think with clear discharge). I've been doing pelvic floor exercises daily to help. Also had a few sporadic night sweats. However, in the last few days I've felt bloated and started spotting with more bleeding (including small clots of dark red and brown) today. I'm so confused and don't know what to do now. Am I now too low in oestrogen? Is in insufficient progesterone? Should I give it more time? Go back to Evorel 75? I was so disappointed to see the spotting return.
My gp tends not to give much of an opinion - leaving it to me to "take the lead", so she ok'd the evorel 50. I often feel she hasn't got a clue and can't advise me.
Any suggestions would be really appreciated 😊

[CLKD]

I would give it more time to settle.  If U think that you should up the regime, mayB not all at once, i.e. keep to the 50: I believe it's possible to cut patches in half so that you can add a little extra a few times a night: or add 75 occasionally, some1 will be alone hopefully who has experimented. 

Could you have a prolapse?  This may cause a feeling of 'heaviness' .... again, some1 will probably be along with info.

GPs don't always know much about peri, U could ask for a referral to a dedicated menopause clinic, NOT a gynae..  There are waiting lists both NHS and private Clinics so getting onto a list might be the way to go: U can always cancel the appt. if you have improved.  Suggest to your GP that you feel it wise for you to get more advice which you can discuss with her/him, it's about learning together as so many medics simply have no idea. 

[Hezzi]

Thanks for your reply CLKD! I really appreciate your support! I will bear in mind the cutting of a patch in half - or in a quarter - do you think that doing this still gives sufficient progesterone?
I'm a bit apprehensive about restarting Evorel 75 with the provera because of all the effects, though maybe I didn't give that enough time either (I'm soooo impatient with this!). Not sure if the reaction was down to the provera (heard some people have reaction similar).
I guess prolapse may be it - I think I had a very small one years ago, though after doing the pelvic floor exercises this got better, but I also started hrt at the same time and wondered - does oestrogen have an effect on this? As you say  hopefully someone will be along with info.
Im deffo post menopausal though - last "period" was in 2017 (I think!), so I'm on continual hrt.

[Hurdity]

Hi Hezzi

Sorry to hear about your problems

Can you say what the result of your scan was in terms of the thickness of the endometrium (womb lining)? And also what sort of scan it was - Ultrasound or transvaginal or both?

If everything has been deemed OK that recently, then it should not be a worry but as you have had clots then do keep an eye on it?

Also not quite clear whether you are on Evorel 50 + Provera, or Evorel conti - the combi patch - since you originally said you were on what you call combined Evorel 50.

Cutting patches is off licence. Theoretically, if that combi patch suits you, you could increase the oestrogen dose by cutting an Evorel conti patch and adding a bit extra, which, if it is a combi patch, would also give you increased progestogen. Alternatively then the other combo could be better and licensed ie separate oestrogen and progestogen - the Evorel 75 mcg and Provera that you had earlier - but you would need to give it 6 months to settle and might expect further intermittent spotting during this time.

The fact that you still have some sweats indicates the need for higher oestrogen.

Hope this helps

Hurdity x

[Hezzi]

Hi Hurdity! Thanks for your reply and your support!. Sorry, they didn't say about the thickness, other than it was "totally normal" and it was both scans. Radiographer said that she couldn't see my ovaries 😳 but felt that they must have shrunk! Will keep an eye on the clots, but now feel reassured with the normal scans only 2 weeks ago. I'm on Evorel conti 50 mcgs and feel generally they have worked really well for me. Since starting them last year, I had virtually no side effects until Christmas there, when after a virus I felt I was not getting enough oestrogen, hence the increase to Evorel 75mcgs. Perhaps it was the provera I had the side effects from 🤔.
As you and CLKD have both suggested cutting a patch to add in a little more I'm gonna give this a try - with slow increases to see how this goes.
Thanks again for your help.

[Hollyboll]

Hiya

Sorry to hear you've felt grotty and worried.

I know how tempting it is to change doses when we don't feel something's working.  I've learned the hard way (after being repeatedly told to increase doses and then having to reduce them once they were ludicrously high and I finally saw an actual specialist) that changes to doses (= fluctuations) as the levels themselves.  Definitely true for bleeding and cramping, and I think to a lesser extent for the others.  I'm not absolutely clear how many weeks you gave the increase before reducing it again, but generally the experts say 6-12 weeks to let doses settle.  So it may simply be that you have chopped and changed a bit, and it's worth letting things settle and if you do then change again, as others have suggested, do it gradually by cutting patches.  FWIW I definitely wouldn't add eg 75 occasionally - that's more fluctuations ...

Hope that helps xx